The Role of CT ScanningIn the Investigation of Biliary

and Pancreatic Conditions

Computerised Axial Tomography

X-ray tube that rotates around your body◦ Whilst you lay flat on a bed non-invasive◦ Produces slices of the body

Provide more detail than standard X-rays

Scans take 10 – 30 minutes depending on location

Can be done with contrast to enhance images

CT Scanning

NHS Choices (2012)

http://www.siemens.co.in/pool/press/news_archive/somatom_definition_as17.jpg

Gold Standard Imaging technique essential Done as contrast CT unless Haemorrhage suspected

Pancreatitis done after 72 hours◦ Assess levels of necrosis ◦ Signs of fluid collection or abscess formation◦ Pseudocyst development

Carcinoma confirm the presence of lesion◦ Determination of whether legion is operable◦ Determine whether metastasis has occurred

Pancreas

UCSD Radiology Dept (2009)Kumar & Clark (2012)

Demos T C et al. (2002)

Cystic fibrosis with cystosis in 33-year-old man.

Demos T C et al. AJR 2002;179:1375-1388

©2002 by American Roentgen Ray Society

Lymphoepithelial cyst in asymptomatic 54-year-old woman.

Demos T C et al. AJR 2002;179:1375-1388

©2002 by American Roentgen Ray Society

Cholecystitis observation of signs of inflammation◦ Determine any complications signs of gas or abscesses◦ Calcification porcelain gallbladder

Gallstones Alternative method◦ Opaque stones more readily detected

Exclusion of other causes of obstruction◦ Carcinoma at the head of the pancreas

Carcinoma observation of masses solid/polypoid◦ Observation of asymmetric or symmetric wall thickening

Biliary

Grand D et al. AJR (2004)Kumar & Clark (2012)

Contrast-enhanced CT scan obtained in 45-year-old man shows low-density gallstones.

Grand D et al. AJR 2004;183:163-170

©2004 by American Roentgen Ray Society

Contrast-enhanced CT scan obtained in 72-year-old man with emphysematous cholecystitis reveals air in gallbladder lumen and thickening of wall.

Grand D et al. AJR 2004;183:163-170

©2004 by American Roentgen Ray Society

NHS Choices (2012) NHS

http://www.nhs.uk/Conditions/CT-scan/Pages/Introduction.aspx University College San Diego Radiology Department (2009)

http://radiology.ucsd.edu/body_image/pdfs/physician/body_ct_protocols5-26-09.pdf CT of the Gallbladder: Spectrum of Disease, Grand, D, Horton, K.M, Fishman, E. American

Journal of Roentgenology July 2004 vol. 183 no. 1 163-170 ARRS http://www.ajronline.org/content/183/1/163.full

Cystic Lesions of the Pancreas, Demos, T.C., Posniak, H.V., Harmath, C, Olson, M.C., Aranha, G., American Journal of Roentgenology December 2002 vol. 179 no. 6 1375-1388 ARRS

http://www.ajronline.org/content/179/6/1375.full Kumar & Clark’s Clinical Medicine, 8th Edition (2012) Kumar, P & Clark, M, Elsevier

References